MEDICARE: PROF. BRENDA DIAZ-LEHMAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9107228	FL

General Provider Information

NPI Number	:	1023191251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BRENDA DIAZ-LEHMAN PA-C

Provider Business Mailing Address
First Line	:	1110 E GIBSON ST
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-5011
Country	:	US
Telephone Number	:	941-494-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 E GIBSON ST
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-5011
Country	:	US
Telephone Number	:	941-494-6222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/07/2013

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